title: Widespread high grade prostatic intraepithelial neoplasia on biopsy predicts the risk of prostate cancer: a 12 months analysis after three consecutive prostate biopsies.
abstract: OBJECTIVE
  To evaluate the risk of prostate cancer (PCa) on a third prostate biopsy in a group of patients with two consecutive diagnoses of high grade intraepithelial neoplasia (HGPIN).
  
  
  METHODS
  From November 2004 to December 2007, patients referred to our clinic with a PSA ! 4 ng/ml or an abnormal digital rectal examination (DRE) were scheduled for trans-rectal ultrasound (TRUS) guided 12-core prostate biopsy. Patients with HGPIN underwent a second prostate biopsy, and if the results of such procedure yielded a second diagnosis of HGPIN, we proposed a third 12-core needle biopsy regardless of PSA value. Crude and adjusted logistic regressions were used to assess predictors of PCa on the third biopsy.
  
  
  RESULTS
  A total of 650 patients underwent 12 cores transrectal ultrasound prostatic biopsy in the study period. Of 147 (22%) men with a diagnosis of HGPIN, 117 underwent a second prostatic biopsy after six months and 43 a third biopsy after other six months. After the third biopsy, 19 patients (34%) still showed HGPIN, 15 (35%) were diagnosed with PCa and 9 (21%) presented with chronic prostatitis. Widespread HGPIN on a second biopsy was significantly associated with PCa on further biopsy (!2 = 4.04, p = 0.04). Moreover, the presence of widespread HGPIN significantly predicted the risk of PCa on crude and adjusted logistic regressions.
  
  
  CONCLUSIONS
  Widespread HGPIN on second biopsy is associated with the presence of PCa on a third biopsy. Nonetheless, the relationship between HGPIN and PCa remains complex and further studies are needed to confirm our findings.
authors.affiliation: Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy. cosimodenunzio@virgilio.it
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Simone
authors.initials: S
authors.lastname: Albisinni
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Costantino
authors.initials: C
authors.lastname: Leonardo
authors.forename: Francesco
authors.initials: F
authors.lastname: Esperto
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000368:Aged; D001707:Biopsy, Needle; D002908:Chronic Disease; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D011472:Prostatitis / Q000453:epidemiology / Q000473:pathology; D012306:Risk; D018084:Ultrasonography, Interventional